Market Regulation

Market regulation refers to regulatory oversight that primarily focuses on regulated entities’ compliance with insurance laws and regulations other than those related to financial solvency. Market regulation complements financial solvency regulation. For example, problems spotted during a market conduct review may be a precursor to financial solvency concerns or vice versa. Market regulation also evaluates companies’ fulfillment of contractual obligations to their policyholders and claimants. Staff members perform a combination of in-house reviews and on-site, targeted examinations of company submissions, records and operations in order to execute these responsibilities. They also coordinate multi-state examinations through the National Association of Insurance Commissioners (NAIC).

The Office of Market Regulation is housed within the Market and Consumer Services Division and is responsible for monitoring the market conduct activity of regulated entities and individuals with a primary focus on domestic and foreign insurers and Health Maintenance Organizations (HMOs). Its purpose is to monitor compliance with applicable laws, regulatory guidance, and contract language. Areas of analysis include, but are not limited to, the following: Policyholder Treatment, Sales, Marketing, Underwriting and Rating, Agent Appointments and Terminations, Provider Relations and Delivery Systems, and Claims Practices.

In order to proactively identify general market disruptions and to eliminate or limit harm to consumers, policyholders and/or claimants, the Office of Market Regulation identifies and prioritizes domestic and foreign regulated entities based upon a variety of factors, including:

Consumer complaints filed with the Department's Office of Consumer Services,